The Centers for Disease Control and Prevention (CDC) recommends eye protection for a

variety of potential exposure settings where workers may be at risk of acquiring infectious
diseases via ocular exposure. This document provides background information and
specific details on eye protection that can be used to supplement eye protection
recommendations provided in current CDC infection control guidance documents. It is
intended to familiarize workers with the various types of eye protection available, their
characteristics, and their applicable use. Workers should understand that regular
prescription eyeglasses and contact lenses are not considered eye protection.

Infectious diseases can be transmitted through various mechanisms, among which are
infections that can be introduced through the mucous membranes of the eye
(conjunctiva). These include viruses and bacteria than can cause conjunctivitis (e.g.,
adenovirus, herpes simplex, Staphylococcus aureus) and viruses that can cause
systemic infections, including bloodborne viruses (e.g. hepatitis B and C viruses, human
immunodeficiency virus), herpes viruses, and rhinoviruses. Infectious agents are
introduced to the eye either directly (e.g., blood splashes, respiratory droplets generated
during coughing or suctioning) or from touching the eyes with contaminated fingers or
other objects.

Eye protection provides a barrier to infectious materials entering the eye and is often
used in conjunction with other personal protective equipment (PPE) such as gloves,
gowns, and masks or respirators.

What types of eye protection should be worn?

The eye protection chosen for specific work situations depends upon the circumstances
of exposure, other PPE used, and personal vision needs. There is wide variety in the
types of protective eyewear, and appropriate selection should be based on a number of
factors, the most important of which is the nature and extent of the hazard. Eye
protection must be comfortable and allow for sufficient peripheral vision and must be
adjustable to ensure a secure fit. It may be necessary to provide several different types,
styles, and sizes. Selection of protective eyewear appropriate for a given task should be
made from an evaluation of each activity, including regulatory requirements when
applicable. These hazard assessments require a clear understanding of the work tasks,
including knowledge of the potential routes of exposure and the opportunities for
exposure in the task assessed (nature and extent of worker contact). Exposure incident
reports should be reviewed to identify those incidents (whether or not infection occurred)
that could have been prevented by the proper use of protective eyewear.

Common eye protection devices are as follows:

Goggles

Appropriately fitted, indirectly-vented goggles* with a manufacturer’s anti-fog coating

provide the most reliable practical eye protection from splashes, sprays, and respiratory
droplets. Newer styles of goggles may provide better indirect airflow properties to reduce
fogging, as well as better peripheral vision and more size options for fitting goggles to
different workers. Many styles of goggles fit adequately over prescription glasses with
minimal gaps. However, to be efficacious, goggles must fit snugly, particularly from the
corners of the eye across the brow. While highly effective as eye protection, goggles do
not provide splash or spray protection to other parts of the face.

* Directly-vented goggles may allow penetration by splashes or sprays; therefore, indirectly-

vented or non-vented goggles are preferred for infection control.

Face Shields

Face shields are commonly used as an infection control alternative to goggles.** As

opposed to goggles, a face shield can also provide protection to other facial areas. To
provide better face and eye protection from splashes and sprays, a face shield should
have crown and chin protection and wrap around the face to the point of the ear, which
reduces the likelihood that a splash could go around the edge of the shield and reach the
eyes. Disposable face shields for medical personnel made of light weight films that are
attached to a surgical mask or fit loosely around the face should not be relied upon as
optimal protection.

** In a chemical exposure or industrial setting, faceshields should be used in addition to

goggles, not as a substitute for goggles (ANSI Z87.1-2003 Practice for occupational and
educational eye and face protection).

Safety Glasses

Safety glasses provide impact protection but do not provide the same level of splash or
droplet protection as goggles and generally should not be used for infection control
purposes.

Full-face Respirators

Full facepiece elastomeric respirators and powered air-purifying respirators (PAPRs) are
designed and used for respiratory protection, but because of their design incidentally
provide highly effective eye protection as well. Selection of this type of PPE should be
based on an assessment of the respiratory hazard in an infection control situation, but
will also provide, as an additional benefit, optimal eye protection.

What eye protection is available for prescription lenses users?

Many safety goggles or plano (non-prescription) safety glasses fit comfortably over street
eyewear and can provide satisfactory protection without impairing the fit of the
prescription eyewear. Prescription safety glasses with side protection are available, but
do not protect against splashes or droplets as well as goggles. Special prescription
inserts are available for goggles. When full facepiece elastomeric negative pressure (i.e.,
non-powered) respirators or tight-fitting powered air purifying respirators (PAPRs) are
indicated for respiratory protection, these devices require appropriate prescription inserts
to avoid compromising the seal around the face; PAPRs designed with loose-fitting
facepieces or with hoods that completely cover the head and neck may be more
accommodating to prescription lens wearers.

Contact lenses, by themselves, offer no infection control protection. However, contact

lenses may be worn with any of the recommended eye protection devices, including full-
face respirators. Contact lens users should rigorously adhere to hand washing
guidelines when inserting, adjusting, or removing contact lenses.

What combination of eye protection and other PPE should be used?

Eye protection should be selected in the context of other PPE use requirements. Safety
goggles may not fit properly when used with certain half-face respirators, and similarly,
face shields may not fit properly over some respirators. Once PPE requirements have
been established for a specific infection control situation, the selected PPE should be
pre-tested to assure suitable fit and protection when used as an ensemble. Elastomeric,
full facepiece respirators and powered air-purifying respirators (PAPRs) have the
advantage of incidentally providing optimal eye protection. In situations where all
combinations of PPE may not be readily available to workers, judicious selection of
complementary PPE is important to allow for appropriate protection.

How should potentially contaminated eye protection be removed?

Eye protection should be removed by handling only the portion of this equipment that
secures the device to the head (i.e., plastic temples, elasticized band, ties), as this is
considered relatively "clean." The front and sides of the device (i.e., goggles, face shield)
should not be touched, as these are the surfaces most likely to become contaminated by
sprays, splashes, or droplets during patient care. Non-disposable eye protection should
be placed in a designated receptacle for subsequent cleaning and disinfection. The
sequence of PPE removal should follow a defined regimen that should be developed by
infection control staff and take into consideration the need to remove other PPE
(see donning and removing PPE).

Can another worker reuse my eye protection?

The eyewear described above is generally not disposable and must be disinfected before
reuse. Where possible, each individual worker should be assigned his/her own eye
protection to insure appropriate fit and to minimize the potential of exposing the next
wearer. A labeled container for used (potentially contaminated) eye protection should be
available in the HCW change-out/locker room. Eye protection deposited here can be
collected, disinfected, washed, and then reused.

How should eye protection be disinfected?

Healthcare setting-specific procedures for cleaning and disinfecting used patient care
equipment should be followed for reprocessing reusable eye protection devices.
Manufacturers may be consulted for their guidance and experience in disinfecting their
respective products. Contaminated eye protection devices should be reprocessed in an
area where other soiled equipment is handled. Eye protection should be physically
cleaned and disinfected with the designated hospital disinfectant, rinsed, and allowed to
air dry. Gloves should be worn when cleaning and disinfecting these devices.